Alternatives to the War on Drugs

Dr. Evan Wood is director of the Urban Health Research Initiative, research scientist at the British Columbia Centre for Excellence in HIV/AIDS and associate professor at the Department of Medicine of the University of British Columbia. Am Johal interviewed him in Vancouver.

Am Johal: You were involved with drafting the Vienna Declaration ahead of the 2010 AIDS conference scheduled for Vienna. Can you outline its basic premise and why this was released at this time?

Evan Wood: The Vienna Declaration is a scientific statement drafted by a large international writing committee, which included various leaders in medicine and public health including Francoise Barre-Sinoussi, who won the Nobel Prize for medicine in 2008. The declaration is available online to read and we are inviting endorsements from the public: www.viennadeclaration.com.

The declaration basically stresses that conventional law-enforcement approaches for addressing the illicit drug problem have failed to achieve their stated objectives and have resulted in a range of unintended harms. The "war on drugs" was initiated to improve community health and safety by reducing the availability of drugs and reducing violence. What has been observed is the opposite. Illegal drugs are generally less expensive and more pure than at any time in our history. Young people now report easier access to marijuana than alcohol or tobacco. So, the starting point is that drug prohibition has failed with respect to its primary objective. With this reality in mind, we must also consider that drug prohibition has resulted in a range of harms. These include the spread of HIV among injection drug users as well as the enrichment of organized crime and related violence. The violence we have been seeing among the different gangs in the lower mainland of Vancouver is a natural consequence of drug prohibition.

AJ: The International Narcotics Control Board is also based in Vienna and has made very public comments against Insite and has also criticized other countries for similar approaches. On the other hand, the U.N. Office of Drugs and Crime has taken a more even-handed approach by recognizing health interventions such as harm reduction from a human rights perspective. What would be your message to a quasi-international U.N.-affiliated institution like the INCB that criticizes nation-states for following health-based interventions related to drug addiction?

EW: The INCB is singled out for special mention in the Vienna Declaration because it has a long history of emphasizing compliance with the U.N. conventions while ignoring the human rights abuses and other harms of the war on drugs. As reported by Human Rights Watch, in some countries, like Thailand, there have been severe human rights atrocities with police walking up behind suspected drug users and shooting them. In their annual reports the INCB basically supported Thailand's anti-drug efforts and made no mention of the over 2000 extrajudicial killings. There is an ironic story about the INCB and Insite that the media has not covered but has been reported in the legal literature. Apparently, the INCB solicited a legal opinion about Insite from the U.N.'s legal department which concluded that the program is not in violation of the U.N. drug conventions, but they have since chosen to ignore this and they continue to say that Insite is illegal.

AJ: The BC Centre for Excellence in HIV/AIDS and International Centre for Science in Drug Policy released a paper in partnership with the International AIDS society this week. What were the main findings?

EW: The main conclusion of the Vienna Declaration is that conventional law-enforcement approaches to address drug-related harm have failed and actually increase violence, HIV rates and other harms. There has also been a failure to scale up evidence-based approaches. For instance, methadone maintenance therapy is probably the most effective treatment for heroin addiction but it remains illegal in places like Russia where over 1 percent of the adult population is now HIV infected largely because of heroin use. This ban persists despite methadone being on the World Health Organization's List of Essential Medicines.

AJ: You have been involved in a number of peer-reviewed studies related to Insite since it opened in 2003. Can you outline the main benefits of this service? The federal government under the Conservative Party has decided to appeal the Insite decision to the Supreme Court? What would be your message to the government around the legal approaches being used to attempt to shut Insite down?

EW: Insite is undoubtedly the most highly studied health clinic in Canadian history. Studies published in The British Medical Journal, The Lancet, The New England Journal of Medicine and the like have demonstrated that the program reduces public disorder resulting from public injection drug use, reduces HIV and overdose rates and improves uptake of addiction treatment. The situation in the downtown eastside has benefited greatly from that program. Given that each case of HIV infection costs the taxpayer an estimated $250,000, we all benefit.

AJ: In the late 90s, there was a lot of movement on the ground to establish the so-called four-pillar approach. I think that most people would now argue that it was never implemented in a full and complete way. Under the present context in 2010, what more needs to be done to reduce the risks of HIV/AIDS, overdose deaths and other communicable diseases related to drug addiction in the inner city in Vancouver?

EW: Four-pillar approaches as applied in Europe place a great deal more emphasis on addiction treatment and harm reduction. Cities generally do not have only one supervised injecting facility. To put it in perspective, there are an estimated 5,000 injection drug users in the downtown eastside and an injecting facility that can accommodate 12 injections at any given time. The staff manages to accommodate well over 500 injections per day, so they can have an impact, but there is a problem with scale-up.

There are elements of the four-pillar approach that are not all that evidence-based. For instance, there is a lot of emphasis on prevention. In fact, opponents of harm reduction often stress the need for focusing on prevention instead of harm reduction. However, the reality is that there are few proven approaches for prevention. The RCMP gets great sums of tax dollars each year for something called Drug Abuse Resistance Education (DARE), despite the fact that a large number of randomized controlled trials have shown it is ineffective. Public service announcements (e.g. this is your brain on drugs) have also proven ineffective. So, whenever I talk about prevention I say that I support funding and rigorously evaluating new prevention tools.

AJ: Anything else?

EW: I'd just like to encourage people to log on to have a look at the Vienna Declaration and consider supporting it.